<p> Questionnaire for Prospective Clients</p><p>The purpose of this questionnaire is to determine the suitability of the financial advisor’s services to the client’s needs. Financial planning is a process that takes place over time. The advisor wishes to work with clients who are committed to improving their financial well-being. We believe that clients will be best served by a long-term relationship with the advisor, if personalities and philosophies otherwise mesh.</p><p>All information provided will be held in the strictest confidence, whether or not we move forward into a contractual relationship.</p><p>Name: Age Name Age</p><p>Address:</p><p>Phone: e-mail for contact:</p><p>Current Employment, if any:</p><p>Annual Gross Income: Estimated Monthly or Annual Expenses:</p><p># of Dependents/Ages</p><p>Please state the primary reasons you are seeking the assistance of a financial planner:</p><p>Financial Self-Assessment: Check the box for each of the areas in which you seek assistance.</p><p> Spending patterns  Investment planning</p><p> Income tax review/reduction  College funding</p><p> Retirement planning  Advisor Investment Management</p><p> Insurance review  Estate Planning</p><p>Do you: (check the appropriate response.) no Yes No Desire desire Do you: assistance Save regularly? Manage your cash flow through a spending plan or a budget? Feel comfortable with your present investment knowledge? Know whether you will pay tax or get a refund this year? Have a will or other estate plan that is current? Financial Inventory: List the current value of your assets.</p><p>Assets Taxable Accounts IRA Accounts 401k & TSA’s Cash/CD’s/T-bills</p><p>Mutual Funds</p><p>Individual Stocks</p><p>Individual Bonds</p><p>Investment Real Estate Residence</p><p>Other Assets:</p><p>Liabilities: Current balance Primary residence</p><p>Home Equity loans</p><p>Auto loans</p><p>Credit cards</p><p>Planner’s Notes:</p>